Following this just past long holiday weekend, the outcome of settling back into a predictable weekend rhythm of data collection and reporting remains unsettled. There are hints that the rate of new cases is slowing, but last week (Sunday, Jan. 10th through Saturday, Jan. 16th) had the second highest weekly count, second only to the just prior week. Our 7-Day average of new cases has been falling from its record high for the last 5 days, but the 14-Day average remains at its highest levels. At the current rate of new cases, we will end January with over 100,000 cases for that single month– a new record high. The Aggregate Total Number of cases continues to climb exponentially. If nothing else changes, we could reach a total of 500,000 Covid-19 cases by the middle of February. Where we go the remainder of this week will likely be telling. I refer the reader to the full portfolio of KHPI’s data visualizations on Tableau Public.
Testing and Test Positivity Rate (TPR). I manually entered the Test Positivity Rates reported by the state since early October into the KHPI database. To make daily calculation of this metric less volitile, the state includes only PCR Viral-RNA tests from swabs, and only from those testing centers that report to the state electronically. Although the major stated reason for calculating this measurement is to determine if enough testing is being done, it is also a truism that if the same kinds of people are being tested and the same number of tests are being performed, that the positivity rate will also reflect the prevalence of active Covid-19 disease in the tested population. Indeed, inspection of the graphic plots shows that the rise and fall of the 14-Day average of new cases tracks the Test Positivity Rate. At least since early October, new cases increased about a week after the Positivity Rate did, and correspondingly decreased when the Positivity Rate did.
We have not yet seen the corner much less turned it.
We anticipate artifactually lower new reported cases and deaths from Covid-19 disease due to holiday work schedules and fewer individuals being tested. New case counts may also be lower recently due to failure of at least parts of the reporting systems of one of the state’s major viral testing laboratories that has not yet been either acknowledged or confirmed by state authorities. If delays and incomplete reporting is the reason, we should expect the record-breaking catch-up counts of the last week to begin to drop, followed much later by a decrease in daily reported Covid-19 deaths. As of January 10, that has not yet happened. At this point, until and unless we see major decreases in daily case and then death counts, we should assume that as is currently the case in many other places in the USA, we are in the middle of a rapidly expanding viral epidemic. The evidence supporting this concern is summarized below and displayed visually on KHPI’s Tableau Public website.
New Record Highs for Daily Cases. We expect in Kentucky and nationally that certain days of the week will have statistically higher or lower case counts than others. For example, Sunday and Monday have been low-count days. It is noteworthy that in each of the past seven weekdays save one, new record highs were set. The exception was last Tuesday, January 5th with 1693 new unduplicated cases. The last time a Tuesday count was lower than that was October 20th with 1297 new cases. You can step visually through the counts by weekday here.
I intended to wait until the end of this week to present my usual Covid-19 status update. I wanted to give our Kentucky testing and reporting system more time to settle out. An initial dramatic fall in new case counts over the December holidays was expected both here and nationally. As might be anticipated, Kentucky’s 7-Day average of new daily cases fell 40% from its post-Thanksgiving record high of 3387 new cases on Dec. 6, to 2021 new cases on Dec. 29. (See figure below.) Some headlines around the country actually reported this as if it represented a turning of the epidemic tide when it actually largely reflected holiday delays in testing and reporting! As of yesterday, Jan. 7, the 7-Day average of new Kentucky cases rebounded to 3150 with back-to-back daily counts of 5705 and 4889 for the two most recent days. Given the very low relative counts of the three previous days, it is virtually certain that our 7-Day average will continue to soar. The same scenario is playing out nationally. “On fire” is a term often used.
I updated the KHPI Covid-19 Tracking files through yesterday’s December 28 numbers. The full profile of data visualizations is available on KHPI’s Tableau Public Website. If one assumes that data collection and reporting have proceeded in unchanged manner since mid-December, the data would be compatible with having turned a corner with respect to new cases. It is possible such an assumption could be partially correct. The same cannot yet be said for deaths or hospital utilization, but we expect those latter markers of epidemic activity to lag behind the identification of new cases. December deaths were in fact markedly higher than previous months.
However, it would be irresponsible to think that nothing else was going on and experts around the country point out that it will take another week or more for things to become clear. In the first place (as with weekends) data collection and reporting around holidays is incomplete or delayed. It cannot be assumed that people are lining up to the same degree to be tested. Indeed, fewer tests were reported recently. What we do know is that people are traveling more over the Christmas holiday in greater numbers than at any time since last March. I have not yet seen a report or prediction that family or other gatherings would remain the same or lower over Christmas or New Year celebrations. Indeed, it is generally assumed there were increased opportunities for the virus to spread at home and elsewhere in the community.
For these reasons, I count myself among those who want badly to believe that things are getting better in Kentucky but do not yet see conclusive evidence that this has happened or is sustainable. We enter a new year with relaxed public health guidelines and continuing public resistance to following even what had been recommended by those who know and care. The effects of effective vaccines will take a while to become apparent. I have little more to offer for now.
Let us all wish for our better angels to help sing in the New Year with us.
Peter Hasselbacher, MD Emeritus Professor of Medicine, UofL 29 December 2020